efavirenz / emtricitabine / tenofovir
Atripla is a combination antiviral medication used to treat human immunodeficiency virus (HIV). It's a tablet that has three active ingredients: efavirenz, emtricitabine, and tenofovir disoproxil fumarate (TDF). Atripla is for adults and children who weigh at least 88 lbs. You take it once a day by mouth on an empty stomach. Some side effects include diarrhea, nausea, and depression. The brand name Atripla isn't sold anymore, but you can still get this medication as a generic.
What is Atripla?
What is Atripla used for?
- HIV treatment
How Atripla works
Atripla contains three antiretroviral medications that work together to fight HIV.
- Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI). It attaches to an HIV protein called reverse transcriptase. This stops the protein from working, which keeps the virus from making more copies of itself.
- Emtricitabine and tenofovir disoproxil fumarate (TDF) are nucleoside reverse transcriptase inhibitors (NRTIs). They get inserted into the virus' DNA, which then blocks reverse transcriptase from working. This prevents HIV from making more copies of itself and spreading in the body.
Drug facts
Side effects of Atripla
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Tiredness (9%)
- Depression (9%)
- Nausea (9%)
- Diarrhea (9%)
- Dizziness (8%)
- Upper respiratory tract infections (8%)
- Sinus infection (8%)
- Rash (7%)
- Headache (6%)
Less Common Side Effects
- Trouble falling asleep or staying asleep
- Strange dreams
- Anxiety
- Vomiting
Atripla serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious liver problems: nausea, stomach pain, loss of appetite, tiredness, yellowing of the skin or whites of the eyes, clay-colored stools
- Changes in mental health: depression, suicidal thoughts and behavior, aggression, abnormal thinking, delusions, paranoia
- Kidney problems: tiredness; urinating less than usual; swelling in your legs, ankles, or feet; muscle pain
- Bone problems: bone pain, misshapen bone, broken bone
- Buildup of lactic acid in the blood (lactic acidosis): feeling more tired or weak, confusion, belly pain, muscle pain, fast heart rate, rapid breathing
- Severe rash: blistering, sores, peeling skin, fever
The following Atripla side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- High lactic acid level—muscle pain or cramps, stomach pain, trouble breathing, general discomfort and fatigue
- Infection—fever, chills, cough, or sore throat
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Lipodystrophy—increased fat in the upper back or midsection, decreased fat in the face, arms, or legs
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
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Pros and cons of Atripla
Pros
- Is a full HIV treatment regimen
- Combines 3 HIV medications into 1 tablet for convenience
- Taken once a day
- Not likely to cause weight gain
- Okay for children weighing at least 88 lbs to take
Cons
- Must take on an empty stomach, preferably at bedtime
- Might have strange dreams while taking
- Interacts with other medications, including some other HIV medications and hepatitis C medications
- Risk of kidney and bone problems
- Not recommended for people with moderate or severe kidney or liver problems
Pharmacist tips for Atripla
- Take Atripla once a day. It might be a good idea take it at bedtime to help with side effects like dizziness, trouble focusing, and problems with coordination.
- Take Atripla on an empty stomach. Swallow the tablet whole with water.
- Set an alarm or reminder so you don't forget to take Atripla every day. Missing doses can make it work less well to keep your HIV infection under control. Make sure to refill Atripla on time so your treatment isn't interrupted.
- Atripla can sometimes make people feel dizzy or drowsy. It can also make people have trouble focusing. If you have these side effects, don't drive or use heavy machines until these side effects go away.
- Avoid drinking alcohol while taking Atripla. Alcohol can make some side effects worse. This includes dizziness, sleepiness, and problems with concentrating worse.
- Some people might get a mild or moderate rash within the first few weeks of taking Atripla. It usually goes away on its own in about a month. But stop taking Atripla and call your prescriber right away if you have a severe rash, blisters, sores, or peeling skin. These are signs of a serious rash that should get checked out.
- Ask your prescriber if you should take calcium and vitamin D supplements to keep your bones strong. Atripla might make your bones weaker than usual. Let your care team know if you break a bone while taking this medication.
- Share a list of all your medications and supplements with your care team. Also, talk to your prescriber or pharmacist before starting any new medications while taking Atripla. They can check for Atripla drug interactions to help keep you safe.
- If you can become pregnant and are having sex, use birth control and condoms while taking Atripla. Keep using birth control for 3 months after stopping this medication. Atripla might harm an unborn baby if it's taken early in pregnancy. Tell your prescriber if you become pregnant while taking Atripla. They can talk to you about your options.
Common questions about Atripla
No, don't crush or split Atripla. This could cause the medication to work less well for you. If you have trouble swallowing the tablet whole, talk to your prescriber about your options.
Atripla isn't usually used for post-exposure prophylaxis (PEP). It's not preferred for helping to prevent an HIV infection after exposure to the virus. Talk to your HIV specialist about better options for PEP. Remember, PEP should be started within 72 hours of exposure (or better yet, as soon as possible).
It's best to take Atripla on an empty stomach. Taking it with food will raise the amount of medication that gets absorbed in your body through your gut. This might make side effects of the medication worse.
People who took Atripla didn't have hair loss during clinical studies. If you notice more hair falling out than usual, talk to a healthcare professional. They can help you figure out what might be causing it.
Atripla isn't associated with weight gain. But if you notice that you're gaining weight during treatment, talk to your primary care provider. They can recommend ways to help you manage your weight.
The three active ingredients in Atripla stay in your body for different amounts of time. After a single dose, efavirenz can stay for up to 16 days. emtricitabine for about 2 days, and tenofovir disoproxil fumarate for around 4 days. These estimates are based on each ingredient's half-life. Even though Atripla stays in your body for a while, it doesn't mean it keeps working well that whole time. It's still important to take Atripla every day to keep your HIV infection under control. Ask your HIV specialist if you have more questions about how long Atripla stays in your system.
Atripla and Biktarvy are both 3-in-1 medications for treating HIV. But they have different ingredients. Atripla contains efavirenz, emtricitabine, and tenofovir disoproxil fumarate. Biktarvy contains bictegravir, emtricitabine, and tenofovir alafenamide. Note that they have different types of tenofovir in them. In addition, Atripla is for adults and children who weigh at least 88 lbs. But Biktarvy is FDA approved for those who weigh at least 31 lbs if they also meet other criteria. Also, clinical guidelines say Biktarvy is a first-choice option for adults and teens who are starting treatment. Talk to your HIV specialist about the differences between these medications.
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Risks and warnings for Atripla
Atripla can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening of hepatitis B infection in people with HIV and hepatitis B
- Risk factors: Have hepatitis B and HIV | Stopping Atripla | Severe liver problems
Before you start taking Atripla, your HIV care team will check if you're also infected with the hepatitis B virus (HBV). It's important for them to know because there's a risk that the HBV infection might get worse after you stop taking Atripla. This could lead to serious liver problems or even liver failure.
If you have HBV and HIV, don't stop taking Atripla without talking with your HIV care team first. If you need to stop, the care team will follow up with you for several months afterwards. They'll probably have you do blood work to check your liver for a hepatitis B flare-up.
Liver problems
- Risk factors: History of liver problems | Hepatitis B or C infection
Although it's rare, some people who took the ingredients of Atripla separately (efavirenz, emtricitabine, and tenofovir disoproxil fumarate) had serious liver damage. This can include a buildup of fat in the liver, which can cause it to swell. Some people needed a liver transplant. And for others, the liver damage was life-threatening. Atripla isn't recommended for people who have moderate or severe liver problems.
Before starting Atripla, you'll need blood tests to check your liver. You'll also have blood tests during treatment to make sure your liver is okay. Stop taking Atripla and get medical help if you have yellowing of your skin or eyes, extreme tiredness, stomach pain, nausea, or loss of appetite. These can be signs of liver problems.
Effects on mental health
- Risk factors: History of mental health conditions | Taking medications for mental health | History of substance use disorder
Some people taking efavirenz, which is in Atripla, had changes in their mental health. Serious problems were rare. But they've included depression, aggression, psychosis, and thoughts of suicide.
If you notice a change in your mood or behavior after starting Atripla, let your prescriber know. It's also helpful to ask trusted friends or family to watch for any changes. Call 911 right away if you start thinking about hurting yourself or others.
Side effects related to the nervous system (e.g., dizziness, trouble sleeping)
- Risk factors: Drinking alcohol | Taking other medications that affect your nervous system
Some people who take Atripla might feel dizzy, sleepy, or confused. They also might have trouble sleeping, strange dreams, or trouble concentrating. These side effects are usually mild or moderate. They often start during the first or second day of taking Atripla. Most times, they get better or go away over time (about 2 to 4 weeks). If these side effects don't get better or start to bother you, talk to your prescriber.
Kidney problems
- Risk factors: History of kidney damage | Also taking other medications that can harm the kidneys
Some people have had kidney problems while taking Atripla. The risk is higher if you also take other medications that can hurt the kidneys. Examples include taking high doses of anti-inflammatory nonsteroidal drugs (NSAIDs) or more than one NSAID at the same time. Atripla isn't recommended for people with moderate or severe kidney problems.
Before starting Atripla, you'll need blood tests and urine tests to check your kidneys. This makes sure it's safe for you to take Atripla. Also get your labs done on time during treatment. It's helpful for your care team to keep checking that your kidneys are safe.
Call your prescriber if you urinate less than usual. Also tell them if you have bone pain, a broken bone, or muscle pain or weakness. These could be signs of kidney problems.
Bone problems
- Risk factors: History of bone fractures | Osteoporosis
Tenofovir disoproxil fumarate, an ingredient in Atripla, can lower your bone mineral density (BMD). This might make your bones weaker. It's possible that these effects can raise the risk of osteoporosis and make it easier for you to break a bone.
Talk to your prescriber about ways to prevent bone problems while taking Atripla. They might suggest calcium and vitamin D supplements to help keep your bones strong. Your prescriber might check your bone density if you break a bone or have other risks for bone problems.
Lactic acidosis
Atripla might raise the risk of a dangerous buildup of lactic acid in your blood (lactic acidosis). Call your care team if you feel weak or confused, have muscle pain, feel your heart racing, or breathing fast. These could be signs of lactic acidosis.
Overactive immune system
- Risk factors: Weakened immune system | Current untreated infection
Taking Atripla can make your body have an intense immune response called immune reconstitution syndrome. When you start taking Atripla, your immune system gets stronger. It can start to fight off infections it couldn't defend against before. This intense immune response can cause a lot of inflammation in the body.
In rare cases, your immune system can become so strong that it starts to attack healthy parts of your body. This can lead to certain autoimmune problems. These problems can show up as early as during the first few weeks of treatment or many months later.
Tell your healthcare team if you have a fever, trouble breathing, or cough after you start Atripla. Also let them know about any new, unusual symptoms like sweating more, hair loss, or bulging eyes. These might be signs of immune reconstitution syndrome and its complications. Your care team can check them out and help you manage them.
Changes in body fat
Even though it's rare, some people taking HIV medications like Atripla might notice changes in their body fat. This includes where it shows up. It can include fat buildup in the back of the neck, breast, and around the middle of the body. Some people also had less fat in the face, arms, and legs. We don't know why this happens and if it'll affect your health later on. Tell your care team if you notice these changes or have concerns while taking Atripla.
Interactions with other medications
Atripla can interact with many medications. Examples include some other HIV medications, hepatitis C medications, and anti-seizure medications. Some drug interactions can make Atripla work less well. This can make it more likely for HIV to spread and become harder to treat. Other drug interactions can raise your risk for side effects.
Because of possible Atripla drug interactions, tell your HIV care team about all the medications you take or plan to take. They can make sure your medications are safe to take together.
Harm to an unborn baby
- Risk factors: Taking Atripla during the first trimester of pregnancy
Some people who took Atripla during the first trimester of pregnancy reported certain birth defects in their baby. If you can get pregnant, it's recommended to use birth control and condoms while taking Atripla. Keep using these birth control methods for 3 months after stopping treatment.
If you're pregnant or trying to become pregnant, talk to your prescriber about your options. There might be safer HIV medications for you.
If you and your prescriber decide that Atripla is the best choice for you during pregnancy, it's a good idea to join the Antiretroviral Pregnancy Registry. This program helps researchers learn about how the medication affects pregnancy. Your prescriber can help you sign up.
Atripla dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 600mg/200mg/300mg | 30 tablets | $47.15 | $1.57 |
Typical dosage for Atripla
Each tablet contains 600 of efavirenz, 300 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate.
For adults and children weighing more than 88 lbs: The typical dose is 1 tablet by mouth once a day on an empty stomach (preferably at bedtime).
Your dose might differ if you weigh 110 lbs or more and you also take rifampin (Rifadin).
How much does Atripla cost?
$47.15
Atripla contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Atripla will not be safe for you to take.
What are alternatives to Atripla?
News about Atripla
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